Treatment Choices by Type and Stage of Stomach Cancer

Treatment Choices by Type and Stage of Stomach Cancer
Treatment of stomach cancer depends to a large degree on where the cancer started in the stomach and how far it has spread.

Stomach cancers can grow and spread in different ways. They can grow through the wall of the stomach and invade nearby organs. They can also spread to the lymph vessels and nearby lymph nodes (bean-sized structures that help fight infections). The stomach has a very rich network of lymph vessels and nodes. As the stomach cancer becomes more advanced, it can travel through the bloodstream and spread (metastasize) to organs such as the liver, lungs, and bones, which can make it harder to treat.

Stage 0
Because stage 0 cancers are limited to the inner lining layer of the stomach and have not grown into deeper layers, they can be treated by surgery alone. No chemotherapy or radiation therapy is needed.

Surgery with either subtotal gastrectomy (removal of part of the stomach) or total gastrectomy (removal of the entire stomach) is often the main treatment for these cancers. Nearby lymph nodes are removed as well.

Some small stage 0 cancers can be treated by endoscopic resection. In this procedure the cancer is removed through an endoscope passed down the throat. This is done more often in Japan, where stomach cancer is often detected early during screening. It is rare to find stomach cancer so early in the United States, so this treatment has not been used as much here. If it is done, it should be at a cancer center that has a great deal of experience with this technique.

Stage I
Stage IA: People with stage IA stomach cancer typically have their cancer removed by total or subtotal gastrectomy. The nearby lymph nodes are also removed. Endoscopic resection may rarely be an option for some small T1a cancers. No further treatment is usually needed after surgery.

Stage IB: The main treatment for this stage of stomach cancer is surgery (total or subtotal gastrectomy). Chemotherapy (chemo) or chemoradiation (chemo plus radiation therapy) may be given before surgery to try to shrink the cancer and make it easier to remove.

After surgery, patients whose lymph nodes (removed at surgery) show no signs of cancer spread are sometimes observed without further treatment, but often doctors will recommend treatment with either chemoradiation or chemo alone after surgery (especially if the patient didn’t get one of these before surgery). Patients who were treated with chemo before surgery may get the same chemo (without radiation) after surgery.

If cancer is found in the lymph nodes, treatment with either chemoradiation, chemo alone, or a combination of the two is often recommended.

If a person is too sick (from other illnesses) to have surgery, they may be treated with chemoradiation if they can tolerate it. Other options include radiation therapy or chemo alone.

Stage II
The main treatment for stage II stomach cancer is surgery to remove all or part of the stomach, the omentum, and nearby lymph nodes. Many patients are treated with chemo or chemoradiation before surgery to try to shrink the cancer and make it easier to remove. Treatment after surgery may include chemo alone or chemoradiation.

If a person is too sick (from other illnesses) to have surgery, they may be treated with chemoradiation if they can tolerate it. Other options include radiation therapy or chemo alone.

Stage III
Surgery is the main treatment for patients with this stage disease (unless they have other medical conditions that make them too ill for it). Some patients may be cured by surgery (along with other treatments), while for others the surgery may be able to help control the cancer or help relieve symptoms.

Some people may get chemo or chemoradiation before surgery to try to shrink the cancer and make it easier to remove. Patients who get chemo before surgery will probably get chemo after, as well. For patients who don’t get chemo before surgery and for those who have surgery but have some cancer left behind, treatment after surgery is usually chemoradiation.

If a person is too sick (from other illnesses) to have surgery, they may be treated with chemoradiation if they can tolerate it. Other options include radiation therapy or chemo alone.

Stage IV
Because stage IV stomach cancer has spread to distant organs, a cure is usually not possible. But treatment can often help keep the cancer under control and help relieve symptoms. This might include surgery, such as a gastric bypass or even a subtotal gastrectomy in some cases, to keep the stomach and/or intestines from becoming blocked (obstructed) or to control bleeding.

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  Stomach Cancer